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<1>
Accession Number
2013585257
Authors
Aceto P. Perilli V. Lai C. Sacco T. Ancona P. Gasperin E. Sollazzi L.
Institution
(Aceto, Lai, Sacco, Ancona, Gasperin, Sollazzi) Department of
Anesthesiology and Intensive Care, A. Gemelli Hospital, Catholic
University of the Sacred Heart, Rome, Italy
(Perilli) Department of Dynamic and Clinical Psychology, University of
Rome Sapienza, Rome, Italy
Title
Update on post-traumatic stress syndrome after anesthesia.
Source
European Review for Medical and Pharmacological Sciences. 17 (13) (pp
1730-1737), 2013. Date of Publication: 2013.
Publisher
Verduci Editore (Via Gregorio VII 186, Roma 00165, Italy)
Abstract
Background: Between 0.5% and 2% of surgical patients undergoing general
anesthesia may experience awareness with explicit recall.These patients
are at a risk for developing anxiety symptoms which may be transient or
can lead to post-traumatic stress disorder (PTSD). AIM: The aim of this
review was to assess the prevalence of PTSD after intraoperative awareness
episodes and analyze patients' complaints, type and timing of assessment
used. METHODS: PubMed, MEDLINE and The Cochrane Li-brary were searched up
until October 2012. Prospective and retrospective studies on human adult
subjects describing prevalence of PTSD and/or psychological sequalae after
awareness episodes were included. Results: Seven studies were identified.
Prevalence of PTSD ranged from 0 to 71%. Acute emotions such as fear,
panic, inability to communicate and feeling of helplessness were the only
patients' complaints that were significantly correlated to psychological
sequelae including PTDS. There were cases that reported psychological
symptoms after 2-6 hours from awakening (%) or 30 days after (%). Previous
studies used psychological scales lacking of dissociation assessment.
Conclusions: Whenever an awareness episode is suspected, a psychological
assessment with at least three interviews at 2-6 h, 2-36 h and 30 days
must be performed in order to collect symptoms associated with both early
and delayed retrieval of traumatic event. As a dissociative state could
hide the expression of reactive symptoms after intraoperative awareness,
future studies should be focused on detecting dissociative symptoms in
order to carry out a prompt and appropriate treatment aimed at avoiding
long-term psychological disability.

<2>
Accession Number
2013560588
Authors
Wang L. Zang W. Xie D. Ji W. Pan Y. Li Z. Shen J. Shi Y.
Institution
(Wang, Ji, Pan, Li, Shen, Shi) Bio-X Institutes, Key Lab. for the Genetics
of Developmental and Neuropsychiatric Disorders (Ministry of Education),
Shanghai Jiao Tong University, Shanghai, China
(Wang, Zang, Xie) FengHe (ShangHai) Information Technology Co., Ltd,
Shanghai, China
(Ji, Pan, Shi) Shanghai Changning Mental Health Center, Shanghai, China
(Ji, Pan, Shi) Institute of Neuropsychiatric Science and Systems
Biological Medicine, Shanghai Jiao Tong University, Shanghai, China
Title
Drug-Eluting Stents for Acute Coronary Syndrome: A Meta-Analysis of
Randomized Controlled Trials.
Source
PLoS ONE. 8 (9) , 2013. Article Number: e72895. Date of Publication: 05
Sep 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background:Drug-eluting stents (DES) are increasingly used for treatment
of acute coronary syndrome (ACS). However, clinical efficacy and safety of
various types of DES is not well established in these subjects. We
therefore evaluated clinical utility of second-generation and
first-generation DES in patients with ACS by conducting a
meta-analysis.Methods:A search of Medline, Embase, the Cochrane databases,
and Web of Science was made. Randomized controlled trials (RCTs) which
compared second-generation DES (everolimus-eluting stents [EES] or
zotarolimus-eluting stents [ZES]) versus first-generation DES
(sirolimus-eluting stents [SES] or paclitaxe-eluting stents [PES]) in
patients with ACS and provided data on clinical efficacy or safety
endpoints were included. Pooled estimates were calculated using
random-effects model.Result:A total of 2,757 participants with ACS in 6
RCTs were included. Compared with first-generation one, second-generation
DES trended to be associated with the decreased incidence of definite or
probable stent thrombosis in ACS patients (risk ratio [RR] = 0.60, 95%
confidence intervals [CI] 0.33 to 1.07, p = 0.09). However, the rate of
target lesion revascularization (TLR) significantly increased in
second-generation DES (RR = 2.08, 95%CI 1.25 to 3.47, p = 0.005). There
were no significant differences in the incidence of major adverse cardiac
events (MACEs), all-cause death, cardiac death, and recurrent myocardial
infarction between the two arms (all p>0.10). The second-generation EES
showed a tendency towards lower risk of MACEs (p = 0.06) and a beneficial
effect on reducing stent thrombosis episodes (p = 0.009), while the
second-generation ZES presented an increased occurrence of MACEs (p =
0.02) and TLR (p = 0.003).Conclusion:Second-generation DES, especially
EES, appeared to present a lower risk of stent thrombosis, whereas
second-generation ZES might increase the need for repeat revascularization
in ACS patients. During coronary interventional therapy, DES class should
be adequately considered in order to maximize clinical benefit of DES
implantation in these specific subjects. 2013 Wang et al.

<3>
Accession Number
2013558129
Authors
Osnabrugge R.L.J. Mylotte D. Head S.J. Van Mieghem N.M. Nkomo V.T. Lereun
C.M. Bogers A.J.J.C. Piazza N. Kappetein A.P.
Institution
(Osnabrugge, Head, Bogers, Kappetein) Department of Cardiothoracic
Surgery, Erasmus University Medical Center, P.O. Box 2040, 3000 CA
Rotterdam, Netherlands
(Mylotte, Piazza) Department of Interventional Cardiology, McGill
University Health Center, Montreal, QC, Canada
(Mylotte) Galway University Hospital, Galway, Ireland
(Van Mieghem) Department of Interventional Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Nkomo) Division of Cardiovascular Diseases, Department of Internal
Medicine, Mayo Clinic, Rochester, MN, United States
(Lereun) Self-employed Biostatistician, Carrigaline, County Cork, Ireland
(Piazza) Department of Cardiovascular Surgery, German Heart Center,
Munich, Germany
Title
Aortic stenosis in the elderly: Disease prevalence and number of
candidates for transcatheter aortic valve replacement: A meta-analysis and
modeling study.
Source
Journal of the American College of Cardiology. 62 (11) (pp 1002-1012),
2013. Date of Publication: 10 Sep 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives The purpose of this study was to evaluate the prevalence of
aortic stenosis (AS) in the elderly and to estimate the current and future
number of candidates for transcatheter aortic valve replacement (TAVR).
Background Severe AS is a major cause of morbidity and mortality in the
elderly. A proportion of these patients is at high or prohibitive risk for
surgical aortic valve replacement, and is now considered for TAVR. Methods
A systematic search was conducted in multiple databases, and prevalence
rates of patients (>75 years) were pooled. A model was based on a second
systematic literature search of studies on decision making in AS. Monte
Carlo simulations were performed to estimate the number of TAVR candidates
in 19 European countries and North America. Results Data from 7 studies (n
= 9,723 subjects) were used. The pooled prevalence of all AS in the
elderly was 12.4% (95% confidence interval [CI]: 6.6% to 18.2%), and the
prevalence of severe AS was 3.4% (95% CI: 1.1% to 5.7%). Among elderly
patients with severe AS, 75.6% (95% CI: 65.8% to 85.4%) were symptomatic,
and 40.5% (95% CI: 35.8% to 45.1%) of these patients were not treated
surgically. Of those, 40.3% (95% CI: 33.8% to 46.7%) received TAVR. Of the
high-risk patients, 5.2% were TAVR candidates. Projections showed that
there are approximately 189,836 (95% CI: 80,281 to 347,372) TAVR
candidates in the European countries and 102,558 (95% CI: 43,612 to
187,002) in North America. Annually, there are 17,712 (95% CI: 7,590 to
32,691) new TAVR candidates in the European countries and 9,189 (95% CI:
3,898 to 16,682) in North America. Conclusions With a pooled prevalence of
3.4%, the burden of disease among the elderly due to severe AS is
substantial. Under the current indications, approximately 290,000 elderly
patients with severe AS are TAVR candidates. Nearly 27,000 patients become
eligible for TAVR annually. 2013 by the American College of Cardiology
Foundation Published by Elsevier Inc.

<4>
Accession Number
2013587103
Authors
Fearon W.F. Shilane D. Pijls N.H.J. Boothroyd D.B. Tonino P.A.L. Barbato
E. Juni P. De Bruyne B. Hlatky M.A.
Institution
(Fearon, Hlatky) Interventional Cardiology, Stanford University Medical
Center, 300 Pasteur Dr, H2103, Stanford, CA 94305, United States
(Shilane, Boothroyd, Hlatky) Department of Health Research and Policy,
United States
(Pijls, Tonino) University School of Medicine, Stanford, CA, United States
(Pijls, Tonino) Catharina Hospital, Eindhoven, Netherlands
(Barbato, De Bruyne) Cardiovascular Center Aalst, Aalst, Belgium
(Juni) Institute of Social and Preventive Medicine (ISPM), University of
Bern, Switzerland
(Juni) CTU Bern, Department of Clinical Research, University of Bern,
Switzerland
Title
Cost-effectiveness of percutaneous coronary intervention in patients with
stable coronary artery disease and abnormal fractional flow reserve.
Source
Circulation. 128 (12) (pp 1335-1340), 2013. Date of Publication: 17 Sep
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND-: The Fractional Flow Reserve Versus Angiography for
Multivessel Evaluation (FAME) 2 trial demonstrated a significant reduction
in subsequent coronary revascularization among patients with stable angina
and at least 1 coronary lesion with a fractional flow reserve <=0.80 who
were randomized to percutaneous coronary intervention (PCI) compared with
best medical therapy. The economic and quality-of-life implications of PCI
in the setting of an abnormal fractional flow reserve are unknown. METHODS
AND RESULTS-: We calculated the cost of the index hospitalization based on
initial resource use and follow-up costs based on Medicare reimbursements.
We assessed patient utility using the EQ-5D health survey with US weights
at baseline and 1 month and projected quality-adjusted life-years assuming
a linear decline over 3 years in the 1-month utility improvements. We
calculated the incremental cost-effectiveness ratio based on cumulative
costs over 12 months. Initial costs were significantly higher for PCI in
the setting of an abnormal fractional flow reserve than with medical
therapy ($9927 versus $3900, P<0.001), but the $6027 difference narrowed
over 1-year follow-up to $2883 (P<0.001), mostly because of the cost of
subsequent revascularization procedures. Patient utility was improved more
at 1 month with PCI than with medical therapy (0.054 versus 0.001 units,
P<0.001). The incremental cost-effectiveness ratio of PCI was $36 000 per
quality-adjusted life-year, which was robust in bootstrap replications and
in sensitivity analyses. CONCLUSIONS-: PCI of coronary lesions with
reduced fractional flow reserve improves outcomes and appears economically
attractive compared with best medical therapy among patients with stable
angina. 2013 American Heart Association, Inc.

<5>
Accession Number
2013585925
Authors
Tadic M. Ivanovic B. Cuspidi C.
Institution
(Tadic) University Clinical Hospital, Centre Dr Dragisa Misovic, Heroja
Milana Tepica 1, 11000 Belgrade, Serbia
(Ivanovic) Clinical Centre of Serbia, Clinic of Cardiology, Koste
Todorovic 8, 11000 Belgrade, Serbia
(Cuspidi) University of Milan-Bicocca, Istituto Auxologico Italiano,
Clinical Research Unit, Viale della Resistenza 23, 20036 Meda, Italy
Title
Metabolic syndrome and right ventricle: An updated review.
Source
European Journal of Internal Medicine. 24 (7) (pp 608-616), 2013. Date of
Publication: October 2013.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
The cluster of metabolic and hemodynamic abnormalities which characterize
the metabolic syndrome (MS) is responsible for subclinical cardiac and
extra-cardiac damage such as left ventricular hypertrophy, diastolic
dysfunction, carotid atherosclerosis and microalbuminuria. The development
of different non-invasive imaging methods enabled a detail investigation
of right ventricular structure and function, and revealed that right
ventricular remodeling followed changes in the left ventricular structure
and function in patients with arterial hypertension, diabetes or obesity.
Previous investigations also reported that the coexistence of two
components of the MS induced more significant cardiac remodeling than the
presence of only one MS risk-factor. The relationship between different
components of the MS (increased blood pressure, abdominal obesity,
increased fasting glucose level and dyslipidemia) and right ventricular
remodeling could be explained by several hemodynamic and non-hemodynamic
mechanisms. However, the association between right ventricular remodeling
and the MS has not been sufficiently investigated so far. The aim of this
article was to review recent articles focusing on the association between
metabolic syndrome components and the metabolic syndrome itself with
impairments in right ventricular structure and function assessed by
different imaging techniques. 2013 European Federation of Internal
Medicine. Published by Elsevier B.V. All rights reserved.

<6>
Accession Number
2013571761
Authors
Pourmehdi Z. Tabatabaei S. Salimbahrami S. Borzouei S.
Institution
(Pourmehdi) Razi Hospital, Ahwaz University of Medica Sciences, Ahwaz,
Iran, Islamic Republic of
(Tabatabaei) Emam Khomeini Hospital, Ahwaz University of Medical Sciences,
Ahwaz, Iran, Islamic Republic of
(Salimbahrami) Besat Hospital, Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
(Borzouei) Shahid beheshti Hospital, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
Title
The efficacy of intrathecal bupivacaine in combination with general
anesthesia versus general anesthesia alone on time to extubation in
patients with Coronary Artery Bypass Graft (CABG) surgery.
Source
Shiraz E Medical Journal. 14 (1) , 2013. Date of Publication: January
2013.
Publisher
Shiraz University of Medical Sciences (1320 Islington Ave, Suite
2206,Toronto M9A 5C6, Canada)
Abstract
Objective: we compared the use of intrathecal bupivacaine in combination
with general anesthesia to general anesthesia alone in patients undergoing
coronary artery bypass grafting (CABG) surgery for its impact on time to
extubation. Methodology: In this case control double blind study we
compared 34 patients in Imam Khomeini Hospital, Ahwaz, Iran, from May 2011
to September 2011.The patients were randomly assigned to receive general
anesthesia with prior administration of intrathecal bupivacaine 0.5% at a
dosage of 20 mg (bupivacaine or case group n = 17) or general anesthesia
alone (control group n = 17) according to a simple computer-generated
list. Results: Mean extubation time in bupivacaine group was213.00 +/-
3.06 (3h and 33m) and in control group was 257.12 +/- 4.49 minutes (4h and
17m).the difference between two groups was significant(P < 0.05).
Conclusion: Intrathecal bupivacaine offers promise as a useful adjunct in
reducing postoperative time to extubation in coronary artery bypass
grafting (CABG) surgery. 2013, Shiraz E Medical Journal, Shiraz, Iran.
All rights reserved.

<7>
Accession Number
2013475995
Authors
Patel D.S. Anand I.S.
Institution
(Patel, Anand) Department of Pharmacology, Shri Sarvajanik Pharmacy
College, Near Arvind Baug, Mehsana-384 001,Gujarat, India
Title
Thrombus aspiration before angioplasty in primary coronary intervention
for STEMI - Comparison with conventional strategy.
Source
International Journal of Pharmaceutical Research. 4 (4) (pp 67-69), 2012.
Date of Publication: 2012.
Publisher
Association of Indian Pharmacist (B/302, Green Avenue - I, Nr. L P Savani
School Road, Adajan, Surat, Gujarat 395 009, India)
Abstract
The primary percutaneous coronary intervention is the preferred method to
treat ST- segment elevated myocardial infarction. Large thrombus burden
remains challenging in the setting of acute myocardial infarct. In recent
years, many efforts have been made in order to improve the results of
percutaneous coronary intervention in terms of myocardial perfusion. We
describe a thrombus reduction technique in this setting using the
Aspiration Device for primary thrombosuction before actual angioplasty.
Thrombus aspiration is applicable in a large majority of patients with
acute myocardial infarction and results in better reperfusion and clinical
outcomes compared with percutaneous coronary intervention alone. Adjunct
thrombi Aspiration reduce mortality in patients undergoing percutaneous
coronary intervention for ST- segment elevated myocardial infarction with
high risk angiographic characteristic. This Aspiration thrombectomy has
received a Class IIa indication with primary percutaneous coronary
intervention in the recent 2007, American College of Cardiology (ACC)/
American Heart Association (AHA) and European Society of Cardiology (ESC)
Guidelines.

<8>
Accession Number
2013554600
Authors
Encarnacion III D.V. Villardo M.V.M.
Institution
(Encarnacion III, Villardo) Department of Adult Cardiology, Philippine
Heart Center, Philippines
Title
The experience of interventional cardiologists in the Philippines on
rapamycin-eluting stent: Clinical outcome and one-year follow-up.
Source
Phillippine Journal of Internal Medicine. 50 (3) , 2012. Date of
Publication: 2012.
Publisher
Philippine College of Physicians (548 Shaw Blvd, Mandaluyong, Metro
Manila, Philippines)
Abstract
Background: Heart and vascular system diseases were the leading causes of
mortality in the Philippines in 2003 at rates of 83.5 per 100,000
population, and 64 per 100,000 population, respectively. Treatment options
for coronary artery revascularization include coronary artery bypass
grafting (CABG) and percutaneous coronary intervention (PCI). Numerous
randomized controlled trials have demonstrated great advantages of DES
over BMS in reducing both restenosis and the occurrence of major adverse
cardiac events (MACE). Despite various mechanical techniques such as
dilatation, debulking, or conventional stent implantation, in-stent
restenosis which occurs in about 15% to 20% of stented arteries remains a
major limitation to the clinical success of PCI. Restenosis is mainly due
to elastic recoil, negative vessel remodelling, and more importantly,
neointimal proliferation that occurs when smooth muscle cells are
stimulated by inflammatory mediators released in response to blood vessel
injury induced by angioplasty devices. Objective: The primary objective of
the study is to determine the clinical outcome of Filipino patients with
coronary artery diseases who received rapamycineluting stents at the
Philippine Heart Center (PHC). Methods: This study is a systematic review
of patients admitted at PHC from August 2006 to December 2009. Coronary
angioplasty patients who underwent rapamycin drug-eluting stenting and
were followedup for at least 12 months for clinical events were included.
Descriptive statistics was used to analyze the gathered data. Results: A
total of 264 patients who underwent angioplasty at PHC from August 2006 to
December 2009 were retrospectively analyzed. The average patient age was
58.43 years. Patients comprised mostly of males (76.89%). Almost half of
the population had a history of previous myocardial infarction (MI;
48.28%), 3.35% had previously undergone PCI, and one (0.41%) had undergone
CABG. The procedural success rate, defined as residual stenosis of less
than 30% and thrombolysis in myocardial infarction (TIMI) flow grade of
three, was 99.7%. Complete revascularization was achieved in 98.8% of
target lesions. Three patients died-one of cardiac origin, the other of
non-cardiac cause (cerebrovascular accident), while the third died of
cancer (mycosis fungoides) within six months from the procedure.
Conclusion: The final results of the one year followup study suggest that
using rapamycin-eluting stents in routine interventional practice is
associated with a high procedural success rate and low incidence of major
adverse clinical cardiac events (MACCE) during hospitalization and at
one-year follow-up.

<9>
Accession Number
2013548033
Authors
Yoon C.-H. Chung W.-Y. Suh J.-W. Cho Y.-S. Youn T.-J. Chun E.-J. Choi
S.-I. Chae I.-H. Choi D.-J.
Institution
(Yoon, Suh, Cho, Youn, Chae, Choi) Department of Internal Medicine, Seoul
National University, Bundang Hospital, South Korea
(Chung) Department of Internal Medicine, Seoul National University,
Boramae Hospital, South Korea
(Chun, Choi) Department of Radiology, Seoul National University, Bundang
Hospital, South Korea
Title
Distal protection device aggravated microvascular obstruction evaluated by
cardiac MR after primary percutaneous intervention for ST-elevation
myocardial infarction.
Source
International Journal of Cardiology. 167 (5) (pp 2002-2007), 2013. Date of
Publication: 01 Sep 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Protection of distal embolization by balloon occlusion and
thrombus aspiration has not improved microvascular circulation nor
decreased myocardial injury during primary percutaneous intervention (PCI)
for ST-elevation myocardial infarction (STEMI) in randomized trials. In a
prospective randomized trial, we investigated the mechanism of the poor
effect of distal protection and thrombus aspiration (DP-TA) in 126
patients with STEMI. Methods: Patients with first-diagnosed STEMI were
randomly assigned to DP-TA pretreatment or conventional PCI (c-PCI).
Primary endpoint was reduced left ventricular end-diastolic volume (LVEDV)
measured by MRI at post-PCI and 6 months after PCI. Secondary end points
were infarct ratio (infarct size to entire LV size) by delayed enhancement
(DE), area at risk (AAR) ratio (AAR to entire LV size) by T2 high signal,
microvascular occlusion index (MVO) ratio (MVO to entire LV size) by DE,
and myocardial salvage index (MSI: (AAR - infarct size) 100 / AAR) using
cardiac magnetic resonance imaging (MRI) within 3 days after PCI. Results:
Baseline characteristics of the patients including cardiovascular risk
factors and lesion characteristics were similar between the two groups.
DT-PA failed to improve LV remodeling at 6 months (LVEDV 140 +/- 39 vs 133
+/- 37 in c-PCI group, p = 0.418). Infarct ratio, AAR ratio and MSI were
not statistically different between DP-TA group and c-PCI group. However,
MVO ratio was significantly larger in DP-TA group than in c-PCI group (2.4
+/- 2.7 vs 1.1 +/- 1.9, p = 0.045). Conclusion: DP-TA was potentially
hazardous in primary PCI for STEMI by increasing MVO. DP-TA should not be
used in STEMI. 2012 Elsevier Ireland Ltd.

<10>
Accession Number
22518037
Authors
Sa M.P. Soares A.M. Lustosa P.C. Martins W.N. Browne F. Ferraz P.E.
Vasconcelos F.P. Lima R.C.
Institution
(Sa) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico de
Pernambuco, Procape Recife, Brazil.
Title
Meta-analysis of 5,674 patients treated with percutaneous coronary
intervention and drug-eluting stents or coronary artery bypass graft
surgery for unprotected left main coronary artery stenosis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 43 (1) (pp 73-80), 2013.
Date of Publication: Jan 2013.
Abstract
To compare the safety and efficacy of coronary artery bypass grafting
(CABG) with percutaneous coronary intervention (PCI) using drug-eluting
stents (DES) in patients with unprotected left main coronary artery
(ULMCA) disease. MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google
Scholar and reference lists of relevant articles were searched for
clinical studies that reported outcomes at the 1-year follow-up after PCI
with DES and CABG for the treatment of ULMCA stenosis. Sixteen studies
(three randomized controlled trials and 13 observational studies) were
identified and included a total of 5674 patients (2331 for PCI with DES
and 3343 for CABG). At the 1-year follow-up, there was no significant
difference between the CABG and DES groups in the risk for death (odds
ratio [OR] 0.691, P = 0.051) or the composite endpoint of death,
myocardial infarction or stroke (OR 0.832, P = 0.258). The risk for target
vessel revascularization (TVR) was significantly higher in the PCI group
compared with the CABG group (OR 3.597, P < 0.001). The risk of major
adverse cardiac and cerebrovascular events (MACCE) was significantly
higher in the PCI group compared with the CABG group (OR 1.607, P <
0.001). A publication bias was observed regarding the outcome of death and
also a considerable heterogeneity effect on the composite endpoint of
death, myocardial infarction or stroke and MACCE. CABG surgery remains the
best option of treatment for patients with ULMCA disease, with less need
of TVR and lower MACCE rates.

<11>
Accession Number
22466697
Authors
Onorati F. Santini F. Menon T. Amoncelli E. Campanella F. Pechlivanidis K.
Faggian G. Mazzucco A.
Institution
(Onorati) Division of Cardiac Surgery, University of Verona Medical
School, Verona, Italy.
Title
Leukocyte filtration of blood cardioplegia attenuates myocardial damage
and inflammation.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 43 (1) (pp 81-89), 2013.
Date of Publication: Jan 2013.
Abstract
Leukocyte filtration of blood cardioplegia (cLkF) is postulated to reduce
ischaemia-reperfusion myocardial injury. Contradictory results have been
published and few studies have addressed perioperative cytokine leakage
and haemodynamic status after LkF. Thirty patients undergoing isolated
aortic valve replacement were randomized to cLkF (cLkF-Group) or to
standard cold blood cardioplegia (S-Group). Troponin I (TnI) and lactate
were sampled from the coronary sinus at reperfusion. Peripheral TnI and
lactate were collected preoperatively at admission, and in the intensive
care unit (ICU) at 8, 12, 36 and 60 h postoperatively. Cardiac index (CI),
indexed systemic vascular resistances, cardiac cycle efficiency (CCE) and
central venous pressure (CVP) were registered preoperatively, at admission
to the ICU and at the 6th, 12th, 18th, 24th and 36th postoperative hour.
IL-6, IL-8, TNF-alpha and IL-10 were sampled preoperatively, at
reperfusion, on admission to the ICU and the 6th, 18th and 24th
postoperative hours. The cLkF group showed lower TnI (2.4 +/- 0.4 vs. 5.1
+/- 0.8 mug/l, P = 0.0001) and lactate (0.9 +/- 0.1 vs. 1.6 +/- 0.2
mmol/l, P = 0.0001) from the coronary sinus at reperfusion. TnI levels
(group-P = 0.0001, group time-P < 0.0001) and lactate (group time-P =
0.001) remained lower postoperatively after cLkF. Ventricular
defibrillation at aortic declamping was less common in the cLkF-Group
(33.3% vs. S-Group: 93.3%; P = 0.002). Cytokines demonstrated significant
postoperative leakage (time-P = 0.0001 in both groups for IL-6, IL-8,
TNF-alpha, IL-10), with lower pro-inflammatory (IL-6 group-P = 0.0001,
group time-P = 0.0001; IL-8 group-P = 0.0001, group time-P = 0.007;
TNF-alpha group-P = 0.0001; group time-P = 0.012) and higher
anti-inflammatory cytokine secretion after cLkF (IL-10 group-P = 0.005).
Perioperative haemodynamic indices proved to be similar between the two
groups (group-P = NS for CI, SVRI, CCE and CVP). cLkF during blood
cardioplegia attenuates myocardial ischaemia/reperfusion injury and
reduces perioperative leakage of TnI, lactate and pro-inflammatory
cytokines. These data did not result in a better haemodynamic status.

<12>
Accession Number
2013563335
Authors
Conway A. Schadewaldt V. Clark R. Ski C.F. Thompson D.R. Kynoch K. Doering
L.
Institution
(Conway) School of Nursing and Institute of Health and Biomedical
Innovation, Queensland University of Technology, Brisbane, QLD, Australia
(Schadewaldt) Australian Catholic University, Melbourne, VIC, Australia
(Clark) School of Nursing and Midwifery Flinders University, Adelaide, SA,
Australia
(Ski, Thompson) Cardiovascular Research Centre, Australian Catholic
University, Melbourne, VIC, Australia
(Kynoch) The Queensland Centre for Evidence Based Nursing, Midwifery: A
Collaborating Centre of the Joanna Briggs Institute, Mater Health
Services, Brisbane, QLD, Australia
(Doering) School of Nursing, University of California Los Angeles, Los
Angeles, CA, United States
Title
The effectiveness of non-pharmacologic interventions in improving
psychological outcomes for heart transplant recipients: A systematic
review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 11 (6) (pp
112-132), 2013. Date of Publication: 2013.
Publisher
Joanna Briggs Institute (North Terrace, Adelaide SA 5005, Australia)
Abstract
Background The International Society for Heart and Lung Transplantation
recommended in 2006 that intervention studies to maximize psychological
outcomes after transplantation should be conducted. Potentially, studies
reporting on the effectiveness of non-pharmacological interventions in
improving psychological outcomes for heart transplant recipients may have
been published since the call for this research. Thus, further evidence
may currently be available to inform policy and practice decision-making
regarding the implementation of such interventions. Accordingly, an
evaluation of the evidence is required. Objectives The objective of this
review was to identify the effectiveness of non-pharmacological
interventions on psychological outcomes for heart transplant recipients.
Inclusion criteria Types of participants This review considered studies
that included community-living adults of all races and ethnicities who
received a heart transplant (inclusive of multi-organ recipients such as
heart and lung transplants). Types of interventions This review considered
studies that evaluated the effectiveness of any intervention that did not
involve the administration of a medication. These may have been
psychological interventions including, but not limited to, cognitive
behaviour therapy, stress management and psychotherapy as well as other
non-psychological interventions including, but not limited to, exercise
and relaxation techniques. Comparator: This review considered studies that
evaluated the effectiveness of non-pharmacological interventions compared
with no intervention, another variation of a non-pharmacological
intervention, combination of non-pharmacological intervention and
pharmacological intervention or pharmacological intervention. Types of
studies This review considered any experimental study design including
randomized controlled trials, non-randomized controlled trials,
quasi-experimental and before and after studies for inclusion. Types of
outcomes This review considered studies that included the following
outcome measures: * Clinical diagnosis of anxiety * Clinical diagnosis of
depression * Anxiety symptoms as measured by a validated scale *
Depressive symptoms as measured by a validated scale * Symptoms of stress
as measured by a validated scale * Mental health as measured by a
validated quality of life scale. Search strategy A comprehensive
three-step search strategy was used to find published and unpublished
English language studies with no time restrictions. Methodological quality
Retrieved papers were assessed by two independent reviewers prior to
inclusion in the review using the standardized critical appraisal
instrument from the Joanna Briggs Institute, Meta Analysis of Statistics
Assessment and Review Instrument (JBI-MAStARI). Data collection Data was
extracted from studies included in the review using the standardised data
extraction tool from JBI-MAStARI. Data synthesis As statistical pooling
was not possible, the findings are presented in narrative form, including
tables and figures. Results Three studies fulfilled the inclusion
criteria, which involved only 125 participants in total. Of the three
included studies, two were randomized controlled trials and one was a
quasi-experimental trial that incorporated a group of historical matched
controls for comparison. Interventions included hospital-based and
home-based exercise programs and an internet-based psychosocial
intervention that incorporated stress and medical regimen workshops,
monitored discussion groups, access to communication with the transplant
team and information on transplant-related issues. Statistically
significant improvements in anxiety and depressive symptoms and mental
health scores were observed over time in intervention groups. However,
between-group comparisons were not reported. Furthermore, the
methodological quality of the studies was poor due to small sample sizes
and baseline differences between control and intervention groups.
Conclusions There is insufficient high-quality evidence available to draw
conclusions for or against the use of non-pharmacological interventions to
improve psychological outcomes for adult heart transplant recipients. As
such, further research is indicated. the authors 2013.

<13>
Accession Number
2013546254
Authors
Pepe S. Liaw N.Y. Hepponstall M. Sheeran F.L. Yong M.S. D'Udekem Y. Cheung
M.M. Konstantinov I.E.
Institution
(Pepe, Liaw, Sheeran, Yong, D'Udekem, Cheung, Konstantinov) Heart Research
Group, Murdoch Childrens Research Institute, University of Melbourne,
Melbourne, Australia
(Pepe, Liaw, Hepponstall, Sheeran, Yong, D'Udekem, Cheung, Konstantinov)
Department of Paediatrics, University of Melbourne, Melbourne, Australia
(Cheung) Departments of Cardiology, Royal Children's Hospital, Melbourne,
VIC 3052, Australia
(Yong, D'Udekem, Konstantinov) Cardiac Surgery, Royal Children's Hospital,
Melbourne, VIC 3052, Australia
Title
Effect of remote ischemic preconditioning on phosphorylated protein
signaling in children undergoing tetralogy of fallot repair: A randomized
controlled trial.
Source
Journal of the American Heart Association. 2 (3) , 2013. Article Number:
e000095. Date of Publication: 2013.
Publisher
American Heart Association Inc. (7272 Greenville Avenue, Dallas TX
75231-4596, United States)
Abstract
Background-Our previous randomized controlled trial demonstrated
cardiorespiratory protection by remote ischemic preconditioning (RIPC) in
children before cardiac surgery. However, the impact of RIPC on myocardial
prosurvival intracellular signaling remains unknown in cyanosis. RIPC may
augment phosphorylated protein signaling in myocardium and circulating
leukocytes during tetralogy of Fallot (ToF) repair. Methods and
Results--Children (n=40) undergoing ToF repair were double-blind
randomized to RIPC (n=11 boys, 9 girls) or control (sham RIPC: n=9 boys,
11 girls). Blood samples were taken before, immediately after, and 24
hours after cardiopulmonary bypass. Resected right ventricular outflow
tract muscle and leukocytes were processed for protein expression and
mitochondrial respiration. There was no difference in age (7.1+/-3.4
versus 7.1+/-3.4 months), weight (7.7+/-1.8 versus 7.5+/-1.9 kg), or
bypass or aortic cross-clamp times between the groups (control versus
RIPC, mean+/-SD). No differences were seen between the groups for an
increase in the ratio of phosphorylated to total protein for protein
kinase B, p38 mitogen activated protein kinase, signal transducer and
activator of transcription 3, glycogen synthase kinase 3b, heat shock
protein 27, Connexin43, or markers associated with promotion of necrosis
(serum cardiac troponin I), apoptosis (Bax, Bcl-2), and autophagy (Parkin,
Beclin-1, LC3B). A high proportion of total proteins were in
phosphorylated form in control and RIPC myocardium. In leukocytes,
mitochondrial respiration and assessed protein levels did not differ
between groups. Conclusions--In patients with cyanotic heart disease, a
high proportion of proteins are in phosphorylated form. RIPC does not
further enhance phosphorylated protein signaling in myocardium or
circulating leukocytes in children undergoing ToF repair. Clinical Trial
Registration--URL: (http://www.anzctr.org.au/trial_view.aspxid=335613.
Unique identifier: Australian New Zealand Clinical Trials Registry number
ACTRN12610000496011. 2013 The Authors.

<14>
Accession Number
23525440
Authors
Mariani J. Doval H.C. Nul D. Varini S. Grancelli H. Ferrante D. Tognoni G.
Macchia A.
Institution
(Mariani) Fundacion GESICA (Grupo de Estudio de Investigacion Clinica en
Argentina), Buenos Aires, Argentina.
Title
N-3 polyunsaturated fatty acids to prevent atrial fibrillation: updated
systematic review and meta-analysis of randomized controlled trials.
Source
Journal of the American Heart Association. 2 (1) (pp e005033), 2013. Date
of Publication: Feb 2013.
Abstract
Previous studies have suggested that n-3 polyunsaturated fatty acids (n-3
PUFAs) have antiarrhythmic effects on atrial fibrillation (AF). We aimed
to assess the effects of therapy with n-3 PUFAs on the incidence of
recurrent AF and on postoperative AF. Electronic searches were conducted
in Web of Science, Medline, Biological Abstracts, Journal Citation
Reports, and the Cochrane Central Register of Controlled Trials databases.
In addition, data from the recently completed FORARD and OPERA trials were
included. We included randomized controlled trials comparing treatment
with n-3 PUFAs versus control to (1) prevent recurrent AF in patients who
underwent reversion of AF or (2) prevent incident postoperative AF after
cardiac surgery. Of identified studies, 12.9% (16 of 124) were included,
providing data on 4677 patients. Eight studies (1990 patients) evaluated
n-3 PUFA effects on AF recurrence among patients with reverted AF and 8
trials (2687 patients) on postoperative AF. Pooled risk ratios through
random-effects models showed no significant effects on AF recurrence (RR,
0.95; 95% CI, 0.79 to 1.13; I(2), 72%) or on postoperative AF (0.86; 95%
CI, 0.71 to 1.04; I(2), 53.1%). A funnel plot suggested publication bias
among postoperative trials but not among persistent AF trials.
Meta-regression analysis did not find any relationship between doses and
effects (P=0.887 and 0.833 for recurrent and postoperative AF,
respectively). Published clinical trials do not support n-3 PUFAs as
agents aimed at preventing either postoperative or recurrent AF. URL:
http://www.crd.york.ac.uk/PROSPERO. Unique Identifier: CRD42012002199.

<15>
Accession Number
23877854
Authors
Burgazli K.M. Mericliler M. Erenturk S. Polat Z.P. Atmaca N.
Institution
(Burgazli) Department of Internal, Medicine, Angiology, Wuppertal Medical
Center, Wuppertal, Germany.
Title
Early postoperative hemodynamic performances of stented versus stentless
aortic xenografts in aortic valve replacement in elderly patients: a
comparative study.
Source
European review for medical and pharmacological sciences. 17 (14) (pp
1894-1900), 2013. Date of Publication: Jul 2013.
Abstract
Surgical valve replacement is the most commonly performed for aortic
stenosis. Randomized trials comparing stentless to stented bioprostheses
for aortic valve replacement in elderly are scarce. The aim of our study
was comparing and evaluating the early hemodynamic performances of Hancock
stented and FreeStyle stentless xenograft aortic valves in aortic valve
replacement in elderly patients. The study involved 40 patients (27
females and 13 males) older than 75 years old. The study was done during
the postoperative period. Aortic valve replacements of stented and
stentless xenografts were performed to the patients in Group I and Group
II, respectively. Investigations for the echocardiographic results were
completed on the postoperative 8-10th days. Parameters for the evaluation
of hemodynamics were peak pressure gradient, mean pressure gradient and
effective orifice area. The parameters were calculated with Doppler
echocardiography by using specific formulas. Peak pressure gradients in
patients with stented valves were significantly higher than in stentless
valves [Stented valve group 32.45 +/- 7.58 vs Stentless valve group 21.50
+/- 4.77 mmHg] (p < 0.05). Mean pressure gradients were found to be
significantly higher in stented group compared with stented group [Stented
valve group 11.050 +/- 3.2521 vs Stentless valve group 19.350 +/- 6.6036
mmHg] (p < 0.05). The effective orifice area index of implanted valve was
significantly greater in the stentless group, as well [Stentless valve
group 2.5050 +/- 0.6022 vs Stented valve group 1.3050 +/- 0.3316 cm2] (p <
0.05). In early postoperative period, effective orifice areas and pressure
gradients were found higher in stentless valve group.

<16>
Accession Number
2013568683
Authors
Badeaux J. Hawley D.
Institution
(Badeaux, Hawley) Texas Christian University (TCU), Center for Evidence
Based Practice and Research, Center of the Joanna Briggs Institute,
Australia
Title
Effectiveness of intravenous Tranexamic Acid (TXA) administration in
managing perioperative blood loss in patients undergoing spine surgery: A
systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 11 (5) (pp
123-131), 2013. Date of Publication: 2013.
Publisher
Joanna Briggs Institute (North Terrace, Adelaide SA 5005, Australia)
Abstract
Review question/objective Is the intravenous administration of tranexamic
acid (TXA) effective in the management of blood loss during the
perioperative phase of spine surgery? The objective of this review is to
identify the effectiveness of intravenous TXA administration in managing
perioperative blood loss in patients undergoing spine surgery. Background
The fundamental role of the spinal column as the human body's supporting
axis has been a subject of medical study for centuries. References to
spinal column treatment date back to ancient times. Hippocrates (460-377
B.C.) is regarded as the father of spine surgery because of the two
apparatuses he discovered to reduce displaced vertebrae. They are
considered to be the precursors to the sophisticated techniques used in
spine surgery today.¹ In 1814, Clyne was documented to have
made the first incision into the spine which subsequently resulted in
complications associated with blood loss.² Today, patients of
all ages undergo an array of spinal procedures with prodigious results,
yet practitioners continue to fight the battle of surgical blood loss
which can lead to negative patient outcomes.³ The spine is
composed of vertebrae, intervertebral discs, the spinal cord, and vascular
structures which are all supported by ligaments. There are a total of 33
spinal vertebrae which include seven cervical, 12 thoracic, five lumbar,
five sacral and four coccygeal vertebrae. Numerous surgical procedures are
performed on all areas of the spine which include but are not limited to
anterior and posterior spinal fusions, microdiscectomy, laminectomy, and
kyphoplasty. The most common indications for spinal surgical procedures
are: spinal instability, fracture, stenosis, degenerative disease, tumor
resection or removal, disc herniation, vertebral osteomylitis,
tuberculosis, scoliosis and failed previous spinal fusions.⁴
Improvements in surgical techniques and technologies which have evolved
over centuries have afforded surgeons the opportunity to perform extremely
complex spinal surgeries on patients of any age. Although spinal surgery
is performed routinely, it is associated with a considerable amount of
blood loss and subsequent allogeneic blood transfusions. This is
particularly true for surgical procedures performed for spinal
malformation, procedures involving bone grafting from the pelvic bone,
metal implantation, and combined anterior and posterior spinal
procedures.⁵ Several patient and procedural factors are known
to affect intraoperative and postoperative blood loss, which will be
collectively referred to as perioperative blood loss in this review.
Contributing patient factors are patient height, perioperative mean
arterial blood pressure and coagulation status.⁶ Contributing
procedural factors include length and technique of surgical procedure,
number of vertebral levels involved, anesthetic technique, and use of
anti-fibrinolytic medications.³ Blood loss in spinal surgery is
variable and can lead to devastating outcomes if it is not controlled.
Large-vein bleeding is the major source of blood loss and its persistence
can lead to enhanced fibrinolysis which is a potential contributing factor
to blood loss during spinal surgery.⁶ Although the cause of
blood loss is multifactorial, the initiation of blood clotting and
fibrinolysis does not discriminate between different age groups. Blood
loss associated with spinal surgery is a common cause of patient
morbidities such as pulmonary and cerebral edema due to fluid
shifts.⁵ Blood transfusions are often required to maintain
tissue perfusion and prevent end-organ damage when a significant quantity
of intra-operative and postoperative blood is lost. Therefore, patients
may be subjected to the known risks of blood transfusion including
transmission of diseases, transfusion-related reactions, immune
suppression, and a decrease in coagulation factors.^8,9
Different techniques including hypotensive anesthesia, preoperative
autologous blood donation, acute normovolemic hemodilution, perioperative
blood salvage, and the prophylactic administration of synthetic
antifibrinolytic drugs such as Aprotinin, epsilon aminocaproic acid (EACA)
and TXA have been suggested to minimize intraoperative and postoperative
blood loss and the need for blood transfusion requirements during spinal
surgery.⁷ Aprotinin was shown to be effective in slowing down
fibrinolysis, but after it was associated with increased mortality
compared with TXA in a large randomized controlled trial in high-risk
cardiac surgery (RR = 1.55; 95% CI, 0.99 - 2.42 it was removed from the
market and is no longer commercially available in the United
States.^10,11 EACA has been shown to be effective but is
associated with hypotension, cardiac arrhythmias, myopathy, and
rhabdomyolysis. TXA is also considered to have 10 times the potency of
EACA.¹² The perioperative administration of TXA is of
particular interest in spinal surgery because it is the most promising
alternative to either Aprotinin or EACA due to its fewer side effects and
favorable benefit-risk ratio.^13,14 The increased risk of
thrombolytic events with TXA has not been shown in clinical
trials.¹⁵ TXA is a synthetic derivative of the amino acid
lysine and can be used to treat or prevent excessive blood loss during
surgery.¹⁶ It is an antifibrinolytic that competitively
inhibits the activation of plasminogen to plasmin, by binding to specific
sites of both plasminogen and plasmin, a molecule responsible for the
degradation of fibrin.^12,15,17 Fibrin is a protein that forms
the framework of blood clots.¹⁵ Since the introduction of TXA
in the 1960s, several randomized controlled trials and systematic reviews
have been published to support the effectiveness of administering
antifibrinolytic drugs to reduce perioperative blood loss in cardiac and
orthopedic procedures.^11,16,18 More recent studies have shown
the effectiveness of TXA administration in the reduction of blood loss in
patients undergoing spine surgeries. Shapiro et al noted that TXA
significantly reduced (p<0.001) both perioperative blood loss and
allogeneic blood transfusion requirements in spine fusions for treatment
of scoliosis in patients with Duchenne muscular dystrophy.¹⁹
Elwatidy et al found that the prophylactic use of high-dose TXA was an
effective, safe and inexpensive method for reducing blood loss during and
after spine operations.²⁰ Wong et al reported significantly
reduced (p = 0.017) perioperative blood loss during elective posterior
thoracic or lumbar spine fusion with instrumentation in
adults.²¹ A systematic review published in 2008 considered
randomized controlled trials to evaluate the effect of antifibrinolytics
on perioperative blood loss in children who were 18 years of age or
younger undergoing scoliosis surgery.²² A 2008 meta-analysis
conducted by Gill et al evaluated antifibrinolytic agents and the
reduction of blood loss and blood transfusions in patients undergoing
spine surgery.²³ The meta-analysis focused on all
antifibrinolytic agents, whereas this review will focus only on TXA and
include not only randomized controlled trials but also observational
studies.

<17>
Accession Number
2013568682
Authors
Cabilan C.J. Hines S. Munday J.
Institution
(Cabilan, Hines, Munday) Nursing Research Centre, Mater Health Services,
The Queensland Centre for Evidence Based Nursing and Midwifery, Centre of
the Joanna Briggs Institute, Adelaide, Australia
Title
Prehabilitation for surgical patients: A systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 11 (5) (pp
112-122), 2013. Date of Publication: 2013.
Publisher
Joanna Briggs Institute (North Terrace, Adelaide SA 5005, Australia)
Abstract
Review question/objective The objectives of this review are to identify
the impact of prehabilitation on postoperative outcomes. More
specifically, the objectives are to identify: * the impact of
prehabilitation on postoperative functional status; * the impact of
prehabilitation on postoperative healthcare utilization (HCU) such as
readmission, and/or utilization of acute rehabilitation service; * the
impact of prehabilitation on postoperative health-related quality of life
(HRQL); and * the impact of prehabilitation on postoperative pain.
Background Physical functional decline is very common after major surgery.
It can lead to loss of independence of activities of daily living
(ADLs),¹such as walking, toileting, and home care activities;
increased incidence of rehabilitation unit admission and nursing home
placement for the elderly,¹,²; longer hospital stay;
development of postoperative complications; poor health-related quality of
life (HRQL); and morbidity.³ Inactivity is well documented as
one of the leading causes of physical functional decline.^4-6
Inactivity has been observed amongst all hospitalized
individuals⁷ regardless of their present condition.²
Increased pain and anxiety about activity due to "fear of
injury"^8,p.195 after surgery are amongst the contributing
factors.⁸ Individuals who experience physical functional
decline have the tendency to enter a continuing cycle of added inactivity
due to their limited physical capacity.⁹ Prolonged inactivity
may inhibit normal functioning of major organ systems such as the
cardiovascular system, cardiopulmonary system, and musculoskeletal
system.⁴ Every individual's functional ability (defined as
ability to perform activities of daily living)¹⁰ is dependent
on the overall functioning of the major organ systems,^11,12
therefore a decline in one or more of the organ systems also means a
decline of functional ability. For example, a reduction in aerobic
capacity as well as ineffective ventilation and perfusion limit the
individual's capacity to perform physical tasks such as functional
walking⁹; orthostatic hypotension and decreased muscle strength
put the individual at a greater risk of falls and
injury.^10,11,13 Preoperative physical functional status also
contributes to postoperative physical functional decline. Evidence
indicates that individuals who have limited physical fitness
preoperatively have higher rates of morbidity and mortality during their
hospital stay.¹⁴Conversely, individuals who have better
preoperative physical fitness experience less postoperative pain and have
better physical functional status postoperatively.¹⁵ Increasing
physical activity is the most effective intervention to counteract
physical functional decline after surgery. Therapeutic exercise is a form
of physical activity that has been known to improve physical fitness
(defined as the capacity to carry out daily functional tasks).⁹
Current evidence supports exercise rehabilitation to enhance physical
fitness after surgery.^8,9 Exercise rehabilitation has been used
widely as a beneficial and effective intervention to re-establish the
individual's postoperative functional status¹⁵ and
independence.¹⁶ Although these outcomes can be achieved through
exercise rehabilitation, it has been argued that the body deconditions
faster than it recovers.^4,13,17 For example, low-intensity
exercises strengthen the muscles at only 6% per week while inactivity
induces 10%-15% loss of muscle strength per week.⁵ Hence
re-attainment of muscle strength is only possible with prolonged intensive
exercise rehabilitation.⁸ It would therefore be reasonable to
optimize functional status through preoperative rehabilitation or
prehabilitation before surgery. Prehabilitation is defined as the "process
of enhancing functional capacity of the individual to enable him or her to
withstand the stressor of inactivity.11,p.268 Prehabilitation aims to
maintain a normal level of functionality and achieve a quicker recovery of
functional status during postoperative inactivity".^11,12,18 The
theory of prehabilitation originated in sports medicine where athletes
train intensively before a competition to prevent injuries.¹²
In a medical context, prehabilitation is employed to prevent physical
functional decline. Currently prehabilitation programs do not have
standardized exercise protocols.¹⁴ For example, the types of
exercises and exercise duration, intensity and frequency vary across
organizations, but generic prehabilitation programs include the following
exercises: "3-5 minutes of warm-up exercises, 5 minutes of aerobics up to
2-3 times per week, 8 repetitions of strengthening exercises 2 days per
week, 30-second flexibility exercises, and up to 5 repetitions of
functional task training 2-3 times per week".^11,p.272 It is
believed that prehabilitation training is proportionate to its impact on
physical functional status, therefore longer and intensive prehabilitation
training maximizes functional status.¹² Moreover, the length of
prehabilitation training has also not yet been standardized but the
duration of training commonly ranges from four to eight
weeks.^3,19 The effectiveness of prehabilitation has been
increasingly explored through clinical experiments and systematic reviews
especially in orthopedic settings. A systematic review¹⁹
indicated that prehabilitation does not enhance both observed and
self-reported postoperative functioning in orthopedic patients. Moreover,
another systematic review³ that included cardiac surgery
patients investigated the impact of prehabilitation on length of stay
(LOS) and postoperative complications. This review indicated that
prehabilitation in the form of inspiratory muscle training in patients
awaiting cardiac or abdominal surgery reduced postoperative pulmonary
complications and hospital LOS, although the authors reported there was no
significant effect of strengthening exercises for joint replacement
therapy on LOS and postoperative complication rate. Both
reviews^3,19 offer limited data on the impact of prehabilitation
on physical functional status after surgery. In addition, the impact of
prehabilitation on physical functional status in other surgical
populations such as cardiac, colorectal, and thoracic surgeries has not
yet been explored in a systematic review. Therefore, it is necessary to
conduct this systematic review.

<18>
Accession Number
2013573470
Authors
Han Y.-L. Liu J.-N. Jing Q.-M. Ma Y.-Y. Jiang T.-M. Pu K. Zhao R.-P. Zhao
X. Liu H.-W. Xu K. Wang G. Wang B. Sun R.-H. Wang J.
Institution
(Han, Jing, Ma, Zhao, Liu, Xu, Wang, Wang) Department of Cardiology,
Shenyang Northern Hospital, Shenyang, Liaoning, China
(Liu) Institute of Molecular Medicine, Nanjing University, Nanjing, China
(Jiang) Department of Cardiology, General Hospital of Armed Police Force,
Tianjin, China
(Pu) Department of Cardiology, PLA 254 Hospital, Tianjin, China
(Zhao) Department of Cardiology, Baotou Central Hospital, Baotou,
Neimenggu, China
(Sun) The Chinese-Japanese Friendship Hospital, Beijing, China
(Wang) Division of Cardiology, Department of Medicine, College of
Physicians and Surgeons Columbia University, Columbia, NY, United States
Title
The efficacy and safety of pharmacoinvasive therapy with prourokinase for
acute ST-segment elevation myocardial infarction patients with expected
long percutaneous coronary intervention-related delay.
Source
Cardiovascular Therapeutics. 31 (5) (pp 285-290), 2013. Date of
Publication: October 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objectives: To elucidate the efficacy and safety of pharmacoinvasive
therapy by using prourokinase (prouk) in patients with ST-segment
elevation myocardial infarction (STEMI). Background: Patients with STEMI
often have long percutaneous coronary intervention (PCI)-related delays
due to various reasons, which are associated with poor outcomes. Methods:
A randomized study which enrolled patients from four centers in China was
conducted. Patients were randomly assigned to accept routine primary PCI
or prouk-PCI. The primary end points were the angiographic parameters,
including thrombolysis in myocardial infarction (TIMI) flow grade, TIMI
frame count, and myocardial blush grade. Secondary endpoints were
incidence of major adverse cardiac events (MACE, defined as death from all
causes, reinfarction, revascularization, or rehospitalization due to new
or worsening congestive heart failure) at 30 days and 1 year. Results: One
hundred and ninety-seven eligible patients were enrolled, of whom 100 were
randomized to the prouk-PCI group. Significantly more patients in the
prouk-PCI group than in the PCI group had an opened infarct-related artery
on arrival in the catheterization laboratory (48% vs. 21%, P = 0.0002) and
better TIMI frame count after PCI (33 +/- 6 vs. 40 +/- 10, P < 0.001). At
1-year follow-up, there was a trend that patients in the prouk-PCI group
had less chances to have MACE (7.0% vs. 12.6%, P = 0.235) or be readmitted
to hospital due to new or worsening congestive heart failure (1.0% vs.
4.1%, P = 0.209). Conclusion: A strategy of emergent PCI preceded by
fibrinolysis with prouk results in a better myocardial perfusion in
infarct-related artery compared with primary PCI alone in patients with
STEMI and long PCI-related delay. 2012 John Wiley & Sons Ltd.

<19>
Accession Number
2013571213
Authors
Lalani T. Chu V.H. Park L.P. Cecchi E. Corey G.R. Durante-Mangoni E.
Fowler Jr. V.G. Gordon D. Grossi P. Hannan M. Hoen B. Munoz P. Rizk H.
Kanj S.S. Selton-Suty C. Sexton D.J. Spelman D. Ravasio V. Tripodi M.F.
Wang A.
Institution
(Lalani) Infectious Disease Clinical Research Program, Bethesda, MD,
United States
(Chu, Park, Corey, Fowler Jr.) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Cecchi) Maria Vittoria Hospital, Torino, Italy
(Durante-Mangoni, Tripodi) II Universita di Napoli, Naples, Italy
(Gordon) Flinders Medical Centre, Bedford Park, SA, Australia
(Grossi) Ospedale di Circolo Varese, Varese, Italy
(Hannan) Mater Misericordiae University Hospital, Dublin, Ireland
(Hoen) University Medical Center of Besancon, Besancon, France
(Munoz) Hospital General Universitario Gregorio Maranon, Madrid, Spain
(Rizk) Cairo University Medical School, Cairo, Egypt
(Kanj) American University of Beirut Medical Center, Beirut, Lebanon
(Selton-Suty) CHU Nancy-Brabois, Nancy, France
(Sexton, Wang) Department of Medicine, Duke University Medical Center,
Durham, NC, United States
(Spelman) Alfred Hospital, Melbourne, VIC, Australia
(Ravasio) Ospedali Riuniti di Bergamo, Bergamo, Italy
Title
In-hospital and 1-year mortality in patients undergoing early surgery for
prosthetic valve endocarditis.
Source
JAMA Internal Medicine. 173 (16) (pp 1495-1504), 2013. Date of
Publication: 09 Sep 2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
IMPORTANCE: There are limited prospective, controlled data evaluating
survival in patients receiving early surgery vs medical therapy for
prosthetic valve endocarditis (PVE). OBJECTIVE: To determine the
in-hospital and 1-year mortality in patients with PVE who undergo valve
replacement during index hospitalization compared with patients who
receive medical therapy alone, after controlling for survival and
treatment selection bias. DESIGN, SETTING, AND PARTICIPANTS: Participants
were enrolled between June 2000 and December 2006 in the International
Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a
prospective, multinational, observational cohort of patients with
infective endocarditis. Patients hospitalized with definite right- or
left-sided PVE were included in the analysis. We evaluated the effect of
treatment assignment on mortality, after adjusting for biases using a Cox
proportional hazards model that included inverse probability of treatment
weighting and surgery as a time-dependent covariate. The cohort was
stratified by probability (propensity) for surgery, and outcomes were
compared between the treatment groups within each stratum. INTERVENTIONS:
Valve replacement during index hospitalization (early surgery) vs medical
therapy. MAIN OUTCOMES AND MEASURES: In-hospital and 1-year mortality.
RESULTS: Of the 1025 patients with PVE, 490 patients (47.8%) underwent
early surgery and 535 individuals (52.2%) received medical therapy alone.
Compared with medical therapy, early surgery was associated with lower
in-hospital mortality in the unadjusted analysis and after controlling for
treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44
[95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI,
0.49-0.67]). The lower mortality associated with surgery did not persist
after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95%
CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]).
Subgroup analysis indicated a lower in-hospital mortality with early
surgery in the highest surgical propensity quintile (21.2% vs 37.5%; P =
.03). At 1-year follow-up, the reduced mortality with surgery was observed
in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P =
.007) quintiles of surgical propensity. CONCLUSIONS AND RELEVANCE:
Prosthetic valve endocarditis remains associated with a high 1-year
mortality rate. After adjustment for differences in clinical
characteristics and survival bias, early valve replacement was not
associated with lower mortality compared with medical therapy in the
overall cohort. Further studies are needed to define the effect and timing
of surgery in patients with PVE who have indications for surgery.

<20>
Accession Number
2013569518
Authors
Linde C. Gold M.R. Abraham W.T. St John Sutton M. Ghio S. Cerkvenik J.
Daubert C.
Institution
(Linde) Department of Cardiology, Karolinska University Hospital, S-
17176, Stockholm, Sweden
(Gold) Division of Cardiology, Medical University of South Carolina,
Charleston, SC, United States
(Abraham) Division of Cardiovascular Medicine, Davis Heart and Lung
Research Institute, Ohio State University, Columbus,OH, United States
(St John Sutton) University of Pennsylvania Medical Center, Philadelphia,
PA, United States
(Ghio) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Cerkvenik) Medtronic, Inc, Minneapolis, MN, United States
(Daubert) Departement de Cardiologie, CHU, INCERM, CIC-IT 804 Rennes,
France
Title
Long-term impact of cardiac resynchronization therapy in mild heart
failure: 5-year results from the resynchronization reverses remodeling in
systolic left ventricular dysfunction (REVERSE) study.
Source
European Heart Journal. 34 (33) (pp 2592-2599), 2013. Date of Publication:
07 Sep 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundThe benefit of cardiac resynchronization therapy (CRT) among
patients with mild heart failure (HF), reduced left ventricular (LV)
function and wide QRS is well established. We studied the long-term
stability of CRT.MethodsREVERSE was a randomized, double-blind study on
CRT in NYHA Class I and II HF patients with QRS >=120 ms and left
ventricular ejection fraction (LVEF) <=40%. After the randomized phase,
all were programmed to CRT ON and prospectively followed through 5 years
for functional capacity, echocardiography, HF hospitalizations, mortality,
and adverse events. We report the results of the 419 patients initially
assigned to CRT ON.FindingsThe mean follow-up time was 54.8 +/- 13.0
months. After 2 years, the functional and LV remodelling improvements were
maximal. The 6-min hall walk increased by 18.8 +/- 102.3 m and the
Minnesota and Kansas City scores improved by 8.2 +/- 17.8 and 8.2 +/- 17.2
units, respectively. The mean decrease in left ventricular end-systolic
volume index and left ventricular end-diastolic volume index was 23.5 +/-
34.1 mL/m² (P < 0.0001) and 25.4 +/- 37.0 mL/m² (P <
0.0001) and the mean increase in LVEF 6.0 +/- 10.8% (P < 0.0001) with
sustained improvement thereafter. The annualized and 5-year mortality was
2.9 and 13.5% and the annualized and 5-year rate of death or first HF
hospitalization 6.4, and 28.1%. The 5-year LV lead-related complication
rate was 12.5%.ConclusionIn patients with mild HF, CRT produced reverse LV
remodelling accompanied by very low mortality and need for heart failure
hospitalization. These effects were sustained over 5 years. Cardiac
resynchronization therapy in addition to optimal medical therapy produces
long-standing clinical benefits in mild heart failure.Clinical Trial
RegistrationClinicaltrials.gov identifier NCT00271154. 2013 The Author.

<21>
Accession Number
2013567796
Authors
Saffi M.A.L. Furtado M.V. Montenegro M.M. Ribeiro I.W.J. Kampits C.
Rabelo-Silva E.R. Polanczyk C.A. Rosing C.K. Haas A.N.
Institution
(Saffi, Furtado, Rabelo-Silva, Polanczyk) Hospital de Clinicas de Porto
Alegre, Cardiology Division, School of Medicine, Federal University of Rio
Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, Brazil
(Furtado, Polanczyk) Institute for Health Technology Assessment
(IATS-CNPq), Ramiro Barcelos 2350, Porto Alegre, Brazil
(Montenegro, Ribeiro, Kampits, Rosing, Haas) Faculty of Dentistry,
Periodontology, Federal University of Rio Grande do Sul, Ramiro Barcelos
2492, Porto Alegre 90035-003, Brazil
Title
The effect of periodontal therapy on C-reactive protein, endothelial
function, lipids and proinflammatory biomarkers in patients with stable
coronary artery disease: Study protocol for a randomized controlled trial.
Source
Trials. 14 (1) , 2013. Article Number: 283. Date of Publication: 06 Sep
2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Scarce information exists regarding the preventive effect of
periodontal treatment in the recurrence of cardiovascular events.
Prevention may be achieved by targeting risk factors for recurrent
coronary artery disease (CAD) in patients with previous history of
cardiovascular events. The aim of this trial is to compare the effect of
two periodontal treatment approaches on levels of C-reactive protein,
lipids, flow-mediated dilation and serum concentrations of proinflammatory
and endothelial markers in stable CAD patients with periodontitis over a
period of 12 months.Methods/design: This is a randomized, parallel design,
examiner blinded, controlled clinical trial. Individuals from both
genders, 35 years of age and older, with concomitant diagnosis of CAD and
periodontitis will be included. CAD will be defined as the occurrence of
at least one of the following events 6 months prior to entering the trial:
documented history of myocardial infarction; surgical or percutaneous
myocardial revascularization and lesion >50% in at least one coronary
artery assessed by angiography; presence of angina and positive
noninvasive testing of ischemia. Diagnosis of periodontitis will be
defined using the CDC-AAP case definition (>=2 interproximal sites with
clinical attachment loss >=6 mm and >=1 interproximal site with probing
depth >=5 mm). Individuals will have to present at least ten teeth present
to be included. One hundred individuals will be allocated to test
(intensive periodontal treatment comprised by scaling and root planing) or
control (community periodontal treatment consisting of one session of
supragingival plaque removal only) treatment groups. Full-mouth six sites
per tooth periodontal examinations and subgingival biofilm samples will be
conducted at baseline, 3, 6 and 12 months after treatment. The primary
outcome of this study will be C-reactive protein changes over time.
Secondary outcomes include levels of total cholesterol, LDL-C, HDL-C,
triglycerides, IL-1beta, IL-6, TNFalpha, fibrinogen, ICAM-1, VCAM-1 and
E-selectin. These outcomes will be assessed at all time points over 12
months. Flow-mediated dilation will be assessed at baseline, 1, 3 and 6
months after periodontal therapy.Discussion: This trial will provide new
evidence regarding the effect of periodontal treatment on risk markers for
recurrence of cardiovascular events in stable coronary artery disease
patients. Trial registration number: ClinicalTrials.gov Identifier,
NCT01609725. 2013 Saffi et al.; licensee BioMed Central Ltd.

<22>
Accession Number
2013574278
Authors
Yan R.T. Miller J.M. Rochitte C.E. Dewey M. Niinuma H. Clouse M.E. Vavere
A.L. Brinker J. Lima J.A.C. Arbab-Zadeh A.
Institution
(Yan, Miller, Vavere, Brinker, Lima, Arbab-Zadeh) Division of Cardiology,
Johns Hopkins Hospital, Baltimore, MD, United States
(Rochitte) Division of Cardiology, Instituto Do Coracao-InCor, Sao Paulo,
Brazil
(Dewey) Department of Radiology, Charite, Berlin, Germany
(Niinuma) Cardiovascular Center, St. Luke's International Hospital, Tokyo,
Japan
(Clouse) Department of Radiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
Title
Predictors of inaccurate coronary arterial stenosis assessment by CT
angiography.
Source
JACC: Cardiovascular Imaging. 6 (9) (pp 963-972), 2013. Date of
Publication: September 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives This study sought to investigate the clinical and imaging
characteristics associated with diagnostic inaccuracy of computed
tomography angiography (CTA) for detecting obstructive coronary artery
disease (CAD) defined by quantitative coronary angiography (QCA).
Background Although diagnostic performance metrics of CTA have been
reported, there are sparse data on predictors of diagnostic inaccuracy by
CTA. Methods The clinical characteristics of 291 patients (mean age: 59
+/- 10 years; female: 25.8%) enrolled in the multicenter CorE-64 (Coronary
Artery Evaluation Using 64-Row Multi-detector Computed Tomography
Angiography) study were examined. Pre-defined CTA segment-level
characteristics of all true-positive (N = 237), false-positive (N = 115),
false-negative (FN) (N = 159), and a random subset of true-negative
segments (N = 511) for >=50% stenosis with QCA as the reference standard
were blindly abstracted in a central core laboratory. Factors
independently associated with corresponding levels of CTA diagnostic
inaccuracies on a patient level and coronary artery segment level were
determined using multivariable logistic regression models and generalized
estimating equations, respectively. Results An Agatston calcium score of
>=1 per patient (odds ratio [OR]: 5.2; 95% confidence interval [CI]: 1.1
to 24.6) and the presence of within-segment calcification (OR: 10.2; 95%
CI: 5.2 to 19.8) predicted false-positive diagnoses. Conversely, absence
of within-segment calcification was an independent predictor of an FN
diagnosis (OR: 2.0; 95% CI: 1.2 to 3.5). Prior percutaneous
revascularization was independently associated with patient-level
misdiagnosis of obstructive CAD (OR: 4.2; 95% CI: 1.6 to 11.2). Specific
segment characteristics on CTA, notably segment tortuosity (OR: 3.5; 95%
CI: 2.4 to 5.1), smaller luminal caliber (OR: 0.48; 95% CI: 0.36 to 0.63
per 1-mm increment), and juxta-arterial vein conspicuity (OR: 2.1; 95% CI:
1.4 to 3.2), were independently associated with segment-level
misdiagnoses. Attaining greater intraluminal contrast enhancement
independently lowered the risk of an FN diagnosis (OR: 0.96; 95% CI: 0.94
to 0.99 per 10-Hounsfield unit increment). Conclusions We identified
clinical and readily discernible imaging characteristics on CTA predicting
inaccurate CTA diagnosis of obstructive CAD defined by QCA. Knowledge and
appropriate considerations of these features may improve the diagnostic
accuracy in clinical CTA interpretation. (Diagnostic Accuracy of
Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors
[CORE-64]; NCT00738218). 2013 By Theamerican College of Cardiology
Foundation.

<23>
Accession Number
2013570327
Authors
Shah B. Srinivas V.S. Lu J. Brooks M.M. Bates E.R. Nedeljkovic Z.S.
Escobedo J. Das G.S. Lopez J.J. Feit F.
Institution
(Shah, Feit) New York University School of Medicine, New York, NY, United
States
(Srinivas) Montefiore Medical Center, New York, NY, United States
(Lu, Brooks) University of Pittsburgh, Pittsburgh, PA, United States
(Bates) University of Michigan, Ann Arbor, MI, United States
(Nedeljkovic) Boston University School of Medicine, Boston Medical Center,
Boston, MA, United States
(Escobedo) Mexican Institute of Social Security, Mexico City, Mexico
(Das) University of Minnesota, Minneapolis MN, United States
(Lopez) Loyola University Medical Center, Maywood, IL, United States
Title
Change in enrollment patterns, patient selection, and clinical outcomes
with the availability of drug-eluting stents in the Bypass Angioplasty
Revascularization Investigation 2 Diabetes trial.
Source
American Heart Journal. 166 (3) (pp 519-526.e2), 2013. Date of
Publication: September 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background In the BARI 2D trial, patients with type 2 diabetes and stable
coronary artery disease were randomized to prompt revascularization versus
intensive medical therapy (IMT). This analysis sought to evaluate how the
availability of drug-eluting stents (DESs) has changed practice and
outcomes. Methods In BARI 2D, 1,605 patients were in the percutaneous
coronary intervention (PCI)-intended stratum. As DES became available
midway through recruitment, we report clinical outcomes among patients who
underwent IMT versus prompt PCI with bare-metal stents (BMSs) or DES up to
4 years. Results In North America, after DES became available, selection
for the PCI-intended stratum increased from 73% to 79% (P =.003). Fewer
BMS than DES patients had total occlusions treated or underwent rotational
atherectomy (5.6% vs 9.7%, P =.02, and 1.2% vs 3.7%, P <.01,
respectively). Subsequent revascularization (IMT 39%, BMS 29%, DES 21%, P
<.01) and target vessel revascularization (BMS 16.1% vs DES 9.6%, P =.03)
were lower with DES. Angina at 2 years tended to be less common with DES
(IMT 39%, BMS 37%, DES 29%, P =.04, for 3 groups, P =.07 for DES vs BMS).
The composite of death, myocardial infarction, or stroke was IMT 16.0%,
BMS 20.5%, DES 17.5%; P =.80. Conclusions When DES became available in
North America, patients were more likely to be selected into the
PCI-intended stratum. Compared with patients receiving BMS, those
receiving DES tended to have less target vessel revascularization and
angina. 2013 Mosby, Inc.

<24>
Accession Number
2013570304
Authors
Brilakis E.S. Held C. Meier B. Cools F. Claeys M.J. Cornel J.H. Aylward P.
Lewis B.S. Weaver D. Brandrup-Wognsen G. Stevens S.R. Himmelmann A.
Wallentin L. James S.K.
Institution
(Brilakis) VA North Texas Healthcare System, UT Southwestern Medical
Center, Dallas, TX, United States
(Held, Wallentin, James) Department of Medical Sciences, Cardiology and
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
(Meier) Bern University Hospital, Bern, Switzerland
(Cools) AZ KLINA, Brasschaat, Antwerp, Belgium
(Claeys) University Hospital Antwerp, Antwerp, Belgium
(Cornel) Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar,
Netherlands
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Tonsley, Australia
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Weaver) Henry Ford Heart and Vascular Institute, Detroit, MI, United
States
(Brandrup-Wognsen, Himmelmann) AstraZeneca Research and Development,
Molndal, Sweden
(Stevens) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
Title
Effect of ticagrelor on the outcomes of patients with prior coronary
artery bypass graft surgery: Insights from the PLATelet inhibition and
patient outcomes (PLATO) trial.
Source
American Heart Journal. 166 (3) (pp 474-480), 2013. Date of Publication:
September 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Patients with prior coronary artery bypass graft surgery (CABG)
who present with an acute coronary syndrome have a high risk for recurrent
events. Whether intensive antiplatelet therapy with ticagrelor might be
beneficial compared with clopidogrel is unknown. In this substudy of the
PLATO trial, we studied the effects of randomized treatment dependent on
history of CABG. Methods Patients participating in PLATO were classified
according to whether they had undergone prior CABG. The trial's primary
and secondary end points were compared using Cox proportional hazards
regression. Results Of the 18,613 study patients, 1,133 (6.1%) had prior
CABG. Prior-CABG patients had more high-risk characteristics at study
entry and a 2-fold increase in clinical events during follow-up, but less
major bleeding. The primary end point (composite of cardiovascular death,
myocardial infarction, and stroke) was reduced to a similar extent by
ticagrelor among patients with (19.6% vs 21.4%; adjusted hazard ratio
[HR], 0.91 [0.67, 1.24]) and without (9.2% vs 11.0%; adjusted HR, 0.86
[0.77, 0.96]; P_interaction =.73) prior CABG. Major bleeding was
similar with ticagrelor versus clopidogrel among patients with (8.1% vs
8.7%; adjusted HR, 0.89 [0.55, 1.47]) and without (11.8% vs 11.4%; HR,
1.08 [0.98, 1.20]; P_interaction =.46) prior CABG. Conclusions
Prior-CABG patients presenting with acute coronary syndrome are a
high-risk cohort for death and recurrent cardiovascular events but have a
lower risk for major bleeding. Similar to the results in no-prior-CABG
patients, ticagrelor was associated with a reduction in ischemic events
without an increase in major bleeding. 2013 Mosby, Inc.

<25>
Accession Number
2013570326
Authors
Bagai A. White J.A. Lokhnygina Y. Giugliano R.P. Van De Werf F.
Montalescot G. Armstrong P.W. Tricoci P. Gibson C.M. Califf R.M.
Harrington R.A. Newby L.K.
Institution
(Bagai, White, Lokhnygina, Tricoci, Newby) Duke Clinical Research
Institute, Duke University Medical Center, Durham, NC, United States
(Giugliano) Brigham and Women's Hospital and the TIMI Study Group, Boston,
MA, United States
(Van De Werf) University Hospital of Leuven, Leuven, Belgium
(Montalescot) Institut de Cardiologie, Pitie-Salpetriere Hospital, Paris,
France
(Armstrong) University of Alberta, Edmonton, AB, Canada
(Gibson) Beth Israel Hospital Deaconess Medical Center, Harvard Medical
School, Boston, MA, United States
(Califf) Duke Translational Medicine Institute, Duke University Medical
Center, Durham, NC, United States
(Harrington) Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
Title
Routine early eptifibatide versus delayed provisional use at percutaneous
coronary intervention in high-risk non-ST-segment elevation acute coronary
syndromes patients: An analysis from the Early Glycoprotein IIb/IIIa
Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome trial.
Source
American Heart Journal. 166 (3) (pp 466-473.e1), 2013. Date of
Publication: September 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Aims In the EARLY ACS trial, routine early eptifibatide was not superior
to delayed provisional use at percutaneous coronary intervention (PCI);
however, among PCI-treated patients, numerically fewer ischemic end points
occurred in the upstream eptifibatide group. We sought to further explore
this finding using methods for examination of treatment effect in this
postrandomization subgroup. Methods and results Of 9,406 patients in the
EARLY ACS primary analysis cohort, 9,166 (97.4%) underwent coronary
angiography. We used Cox proportional hazards regression modeling, with
PCI as a time-dependent covariate, to examine the effect of routine early
versus delayed provisional eptifibatide among 5,541 patients undergoing
PCI and to explore the interaction between treatment with PCI and
randomized treatment strategy. After multivariable adjustment, compared
with delayed provisional use, routine early eptifibatide was associated
with lower rate of 30-day death or myocardial infarction (MI) after PCI
(hazard ratio [HR] 0.80, 95% CI 0.68-0.95) but not with medical management
(HR 0.97, 95% CI 0.74-1.29); PCI x randomized treatment interaction term P
=.24. Excluding PCI-related MI, the adjusted HR for 30-day death or MI for
routine early eptifibatide versus delayed provisional use was 0.80 (95% CI
0.60-1.08) for post-PCI treatment and 1.01 (95% CI 0.79-1.34) for medical
management; PCI x randomized treatment interaction term P =.28.
Conclusions Consistent with previous literature, upstream treatment with
eptifibatide was associated with improved outcomes in high-risk
non-ST-segment elevation acute coronary syndrome patients treated with
PCI; however, a nonsignificant interaction term precludes a definite
conclusion. 2013 Mosby, Inc.

<26>
Accession Number
2013547939
Authors
Romeo F. Acconcia M.C. Sergi D. Romeo A. Gensini G.F. Chiarotti F. Caretta
Q.
Institution
(Romeo, Sergi) Department of Cardiovascular Disease, University of Rome,
Tor Vergata - Rome, Italy
(Acconcia, Romeo) Department of Cardiovascular Disease, University of
Rome, La Sapienza - Rome, Italy
(Gensini, Caretta) Department of Medical and Surgical Critical Care,
University of Florence, Viale Morgagni 85, Florence, Italy
(Chiarotti) Department of Cell Biology and Neuroscience, Italian National
Institute of Health, Rome, Italy
Title
Lack of intra-aortic balloon pump effectiveness in high-risk percutaneous
coronary interventions without cardiogenic shock: A comprehensive
meta-analysis of randomised trials and observational studies.
Source
International Journal of Cardiology. 167 (5) (pp 1783-1793), 2013. Date of
Publication: 01 Sep 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background Although controversial, using prophylactic intra-aortic balloon
pump (IABP) in patients undergoing high-risk percutaneous coronary
intervention (PCI) has been reported to be effective by numerous registry
studies. However, conflicting findings were observed in observational
studies (Obs.) and randomised controlled trials (RCTs). Objective The
purpose of this meta-analysis was to assess the impact of IABP on
in-hospital deaths, major adverse cardiovascular events (MACCE),
access-site complications and stroke in high-risk PCI cases from Obs. and
RCTs published from 1st January, 1990 to 31st March, 2012 and indexed in
PubMed. Methods and results We retrieved 1125 studies from the database;
11 studies compared the effects of IABP support, i.e., prophylactic
administration (P-IABP) vs. no support (No-IABP), in high-risk patients
undergoing PCI. These studies were included in the meta-analysis. We then
calculated risk ratios (RRs) and risk differences (RDs) between the two
groups of patients (P-IABP vs. No-IABP). We did not observe significant
in-hospital mortality, MACCE, access-site complications or stroke
differences in the RRs and RDs of the two groups. Conclusions The results
suggest that PCI plus P-IABP support does not result in reduced
in-hospital mortality or MACCE nor in significant higher access-site
complications or stroke incidence compared with PCI alone in patients at
high risk for peri-procedural PCI complications. 2012 Elsevier Ireland
Ltd.

<27>
Accession Number
71165765
Authors
Hunt B.J.
Institution
(Hunt) Thrombosis and Haemostasis, King's College University and Guy's, St
Thomas' NHS Foundation Trust, London, United Kingdom
Title
Fibrinolysis, antifibrinolytics and tangled terminology.
Source
Shock. Conference: 8th Wiggers-Bernard Conference Salzburg Austria.
Conference Start: 20110217 Conference End: 20110218. Conference
Publication: (var.pagings). 38 (4 SUPPL. 1) (pp 21-23), 2012. Date of
Publication: 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
The CRASH-2 study has shown that the use of tranexamic acid (TA), an
antifibrinolytic agent, reduces mortality in those with traumatic
bleeding. This trial has emphasized the importance of fibrinolytic
activation in causing bleeding. The widespread use of thromboelastography
in monitoring traumatic coagulopathy has led to the use of a new language
around fibrinolysis, which is noticeably different from the classic
terminology of fibrinolysis. This author suggests that in future
publications, the word "thromboelastography" or ROTEM is prefixed before
the new terminology to prevent confusion. The largest trial to date of
antifibrinolytics: the Clinical Randomisation of Antifibrinolytics in
Significant Haemorrhage (CRASH-2) trial assessed the effects of
administration of TA within 8 h of injury in trauma patients with, or at
risk of substantial bleeding (1); 20,211 trauma patients from 40 countries
were randomly assigned within 8 h of injury to either TA (1 g load, then 1
g over 8 h) or placebo. The primary outcome was in-hospital mortality
within 4 weeks of injury. All-cause mortality was significantly reduced
with TA (14.5% vs. 16%; relative risk [RR], 0.91; 95% confidence interval
[CI], 0.85-0.97; P = 0.0035). Bleeding-related mortality was also reduced
(4.9% vs. 5.7%, respectively) without an increase in fatal or nonfatal
vascular occlusive events. As a consequence of this trial, tranexamic acid
has been incorporated into trauma bleeding protocols worldwide. The most
recent publication from the CRASH-2 group (2) showed that tranexamic acid
should be given as early as possible to bleeding trauma patients. For
trauma patients admitted late after injury, tranexamic acid was less
effective and could be harmful. This was based on strong evidence that the
effect of tranexamic acid on death due to bleeding varied according to
time from injury. Treatment within an hour of injury produced an RR of
0.68 (95% CI, 0.57-0.82; P < 0.0001). Treatment given between 1 and 3 h
showed an RR of 0.79 (95% CI, 0.64-0.97; P = 0.03). However treatment
given after 3 h seemed to increase the risk of death due to bleeding RR of
1.44 (95% CI, 1.12-1.84; P = 0.004). Despite the reduction in mortality,
TA did not reduce transfusion requirements in CRASH-2. Why might this be?
The first most obvious conclusion is that the study was not designed to
detect a reduction in bleeding. Indeed the management of blood loss during
trauma is not fine-tuned to compensate for losses-blood is given
empirically and not against measure blood losses. Moreover, investigators
were asked to use their normal practice, and the availability of blood
components is variable among the 40 countries of the countries involved,
and it is widely recognized that transfusion practice varies widely
between units (3). Use of blood components is only a very crude measure of
bleeding especially when no trigger for transfusion and stopping
transfusion were given (4). It has also been clearly established that
antifibrinolytic agents reduce blood loss in patients with surgical and
both normal and traumatic injury. A systematic review of randomized trials
assessing tranexamic acid in patients undergoing elective surgery
identified over 50 studies (5). Tranexamic acid reduced the need for blood
transfusion by a third (RR, 0.61; 95% CI, 0.54-0.70). Another systematic
review of randomized trials of antifibrinolytic agents given for bleeding
during the postpartum period concluded that TA reduced blood loss in
postpartum hemorrhage (6). The utility of antifibrinolytics in reducing
blood loss in surgery and death rate in traumatic bleeding implies that
activation of fibrinolysis is important in the coagulopathy of bleeding.
Fibrinolysis is responsible for clot breakdown. Traditionally, definitions
of fibrinolytic activation have been separated into primary and secondary
fibrinolysis: primary fibrinolysis represents increased fibrinolytic
activity independent of other factors, whereas secondary fibrinolysis is a
consequence of activation of coagulation and thus thrombin activation,
which stimulates the endothelium to produce increased amounts of tissue
plasminogen activator. Hyperfibrinolysis is the term used when
fibrinolytic activity is greater than fibrin formation such that clot
integrity is threatened, and there is clot breakdown (7). Tranexamic acid
(fra/w-4-(anunomemyl)cyclohexanecarboxylic acid) is a synthetic derivative
of the amino acid lysine that competitively inhibits the activation of
plasminogen to the serine protease plasmin via binding to kringle domains.
Tranexamic acid is also a competitive inhibitor of tissue plasminogen
activator. Tranexamic acid blocks the lysine-binding sites of plasminogen,
resulting in an inhibition of plasminogen activation and fibrin binding to
plasminogen and therefore to an impairment of fibrinolysis (8). Perhaps
the success of tranexamic acid in reducing mortality in traumatic bleeding
should not be surprising as the potent stimuli of tissue plasminogen
activator from the endothelium are adrenaline, vasopressin, histamine,
hypoxic stress, and thrombin (9,10)-all present in varying degrees in a
bleeding trauma patient. And yet activation of fibrinolysis in trauma and
surgery has been surprisingly poorly studied in the past. Increased levels
of fibrin degradation products (usually D-dimers, which are the breakdown
product of cross-linked fibrin) are measured crudely by near-patient
testing to exclude venous thromboembolism and can be measured precisely by
enzyme-linked immunosorbent assays. Using D-dimer enzyme-linked
immunosorbent assays D-dimer levels have been shown to increase
perioperatively especially in cardiac surgery and liver transplantation
(11). Brohi et al. (12) showed that D-dimer concentrations are raised in
trauma patients at the time of hospital admission (median prehospital time
28 min), with the highest values in the most severely injured patients. A
similar study from Japan (13) also noted increased fibrin degradation
products in severely injured trauma patients. Future studies to study
activation of fibrinolysis in bleeding patients using modern research
assays are still required. Instead, over the last few decades, most of our
information on surgical and traumatic injury comes from the use of
thromboelastography, where assessment has shown that thromboelastographic
detection of increased fibrinolytic activation is associated with risk of
death (14). However, a new language has arisen in the field in
thromboelastography, which uses the old terminology in new ways (Table 1).
With the thromboelastogram (TEG), fibrinolysis is measured by the decrease
in maximal amplitude over 30 min after the maximal amplitude has been
reached (Lys30). The normal range is less than 7.5% The R, K, a angle, and
MA variables can also be incorporated into a coagulation index (CI) as
defined by the equation: CI = -0.6516R 0.3772K + 0.1224MA + 0.0759a 7.7922
(15). The CI functions as an overall assessment of coagulation, with
values less than -3.0 said to signify a hypocoagulable sample and values
over +3.0 said to signify a hypercoagulable sample. It is said that a LY30
greater than 7.5% with a CI less than 1.0 represents primary fibrinolysis;
whereas a LY30 at greater than 7.5% with a CI greater than 3.0 represents
secondary fibrinolysis. However, more recently, the term primary
fibrinolysis has been applied when greater than 15% estimated percent
lysis is detected in TEG in bleeding trauma patients (16). This was seen
in one study on 34% of patients requiring massive transfusion after
traumatic injury and significantly correlated with risk of death. Schochl
et al. (14) used the term hyperfibrinolysis for increased lysis on the
rotational thromboelastometry (ROTEM), again greater than 15% of maximal
amplitude, and such changes were associated with poor prognosis. Thus, it
seems that the trauma world is developing a different language around
increased fibrinolytic activity as detected by TEG and ROTEM compared with
traditional usage. While Lys30 has been shown to correlate with increased
fibrinolysis with an old assay for fibrinolytic activity-the euglobulin
lysis time (17), the relevance of these terms to conventional measurements
such as tissue plasminogen activator levels at present is unclear, and it
remains uncertain how much fibrinolysis is actually occurring undetected
when the Lys30 is less than 7.5%. In view of the justified current
interest in fibrinolysis and bleeding, and to prevent confusion and retain
mutual understanding between the fields, this author would plea that the
term 'TEG or "ROTEM" is used when describing results from
thromboelastographic traces, e.g., TEG hyperfibrinolysis. Also the term
primary fibrinolysis in TEG terminology sits uneasily with the classic
term, perhaps the term TEG hyperfibrinolysis can be used instead?